自采样人乳头瘤病毒DNA检测筛查宫颈癌的应用价值

Application value of self-sampling human papillomavirus DNA test for cervical cancer screening

目的探讨自采样人乳头瘤病毒(HPV)DNA检测在宫颈癌筛查中的应用价值及大众对自采样HPV DNA检测的认知情况。方法选取2021年9月至12月于郑州大学第一附属医院就诊的108例21~69岁女性,进行自采样和医采样HPV DNA检测以及医采样宫颈液基细胞学(TCT)检测。对高危型HPV阳性和(或)TCT异常(意义未明的不典型鳞状细胞及以上)者进行阴道镜检查及活检,同时采用线上调查问卷收集患者对自采样HPV DNA检测取样方法的认知与感受。结果108例入组女性中100例具有完整HPV检测数据,合格率为92.59%。一致性分析显示HPV DNA检测在自采样与医采样中一致性较好(Kappa=0.819,P<0.001),阳性符合率91.11%,阴性符合率90.91%,总符合率91.00%。其中高危型HPV 16/18一致性最好(Kappa=0.818,P<0.001),其他型别一致性一般(Kappa=0.729,P<0.001),其阳性符合率分别为94.74%、90.00%,阴性符合率分别为90.91%、87.14%,总符合率分别为98.00%、88.00%。病理活检确诊为阳性的有16例其中低级别鳞状上皮内病变3例,高级别鳞状上皮内病变7例,宫颈癌6例,其余8例为宫颈炎,自采样HPV DNA检测低级别鳞状上皮内病变的敏感性略低于医采样HPV DNA检测(81.25%、93.75%),但高于TCT(75.00%)。108例参加问卷调查女性年龄(42.11+11.40)岁。其中43.52%了解宫颈癌检测的途径来源于医师或护士的推荐;49.07%对自采样筛查没有顾虑,且认为自采样筛查过程方便(40.74%)、易用性强(39.81%),85.19%期望自采样筛查地点为医院,87.04%认为自采样的体验易操作且舒适,65.74%愿意为自取样支付<50元。结论HPV DNA检测在自采样和医采样中一致性较好,且大部分女性对自采样HPV DNA有积极的态度。

Objective To explore the application value of self-sampling human papillomavirus(HPV)DNA test in cervical cancer screening,and to investigate the public's awareness of self-sampling HPV DNA test.Methods A total of 108 patientsaged 21-69 who were treated in the First Affiliated Hospital of Zhengzhou University from September to December 2021 were selected for vaginal self-sampling and clinician-sampling for HPV DNA test,and clinician-sampling for thinprep cytologic test(TCT).Colposcopy and biopsy were performed for patients with high-risk HPV positive and/or abnormal TCT(≥atypical squamous cells of undetermined significance).At the same time,an online questionnaire was used to collect patients'cognition and attitude towards the self-sampling test.Results The 100 of the 108 enrolled patients had complete HPV testing data,and the pass rate was 92.59%.Consistency analysis showed that self-sampling and clinician-sampling were better in the HPV DNA detection(Kappa=0.819,P<0.001),with positive coincidence rate of 91.11%,negative coincidence rate of 90.91%and total coincidence rate of 91.00%.The consistency of high-risk HPV 16/18 was the best(Kappa=0.818,P<0.001),and the consistency of other types was general(Kappa=0.729,P<0.001),with positive coincidence rates of 94.74%and 90.00%,and negative coincidence rates of 90.91%and 87.14%,respectively.The total coincidence rates were 98.00%and 88.00%,respectively.Sixteen patients were confirmed to be positive by pathological biopsy,included 3 patients of low-grade squamous intraepithelial lesion,7 patients of high-grade squamous intraepithelial lesion,6 patients of cervical cancer.And the remaining 8 patients of cervicitis.The sensitivity of low-grade squamous intraepithelial lesionby self-sampling HPV DNA was slightly lower than that by clinician-sampling HPV DNA(81.25%and 93.75%),but higher than that by TCT(75.00%).The average age of 108 patients was(42.11+11.40).Among them,43.52%of patientslearned about cervical cancer detection from the recommendation of doctors or nurses.49.07%did not worry about self-sampling screening,and thought the process of self-sampling screening was convenient(40.74%)and easy to use(39.81%).85.19%expected the place of self-sampling screening to be a hospital.87.04%of patientsthought the experience of self-sampling was easy to operate and comfortable,and 65.74%were willing to pay less than 50 yuan for self-sampling.Conclusion HPV DNA detection has good consistency between self-sampling and clinician-sampling,and most women had a positive attitude towards self-sampling HPV DNA test.